罗哌卡因腰-硬联合阻滞用于剖宫产术临床研究  

Ropivacaine and bupivacaine for combined spinal-epidural anesthesia for caesarean section

作　　者：苏美玉[1] 马君志[2] 张广慧[1] 

机构地区：[1]河南省濮阳市人民医院麻醉科,濮阳457000 [2]郑州大学第一附属医院

出　　处：《中原医刊》2006年第22期42-43,共2页Central Plains Medical Journal

摘　　要：目的 研究罗哌卡因腰麻-硬膜外联合阻滞用于剖宫产术的临床效果及安全性。方法 择期剖宫产40例，25—32岁。ASAⅠ～Ⅱ级，随机分成两组，每组20例。用1％罗哌卡因（R组）、0．75％布比卡因（B组）各1ml，分别加入10％葡萄糖1ml和3％麻黄素1ml配成重比重溶液。用AS—ES型联合阻滞配套针于第2～3腰椎间隙穿刺。以0．1ml／s的速率蛛网膜下腔给药2ml。术中酌情于硬膜外给予2％利多卡因维持麻醉。比较两组病人在感觉、运动阻滞及恢复上的异同，新生儿Apgar评分及用药后的不良反应。结果 最大阻滞时间两组相似，运动阻滞显效时间和最大运动阻滞时间罗哌卡因组长于布比卡因组（P〈0．05），最大Bromage评分明显小于布比卡因组（P〈0．01），运动恢复时间短于布比卡因组（P〈0．05）。新生儿娩出后1min，5min时Apgar评分差异无统计学意义（P〉0．05）。未见恶心、呕吐等不良反应发生。结论 1％罗哌卡因腰-硬联合阻滞用于剖宫产术安全、有效，与布比卡因比较。对下肢运动神经阻滞弱且恢复快。Objective To investigate the efficacy and safety of ropivacaine and bupivacaine for combined spinal- epidural anesthesia （CSEA）for caesarean section. Methods Forty patients, ASA grade Ⅰ-Ⅱ , 25-32 years old, undergoing elective caesarean section were randomly allocated to receiving spinally hyperbaric mixture 2ml of 1% ropivacaine （group B, n = 20） ,0.75% bupivacaine （ group R, n = 20） , combined with 10% glucose l ml and 3% ephedrine l ml respectively,and the anesthesia was maintained with epidural administration with 2% lidocaine if necessary during the operation, after the AS - ES combined spinal epidural anesthesia, it was applied at the L2-3 clearance . Sensation , motor block, recovery, Apgar score for neonates, adverse during operation were observed and compared. Results The time to maximum spread of anesthesia was similar in group R and group B. Compared with ones in group B, the onset of motor block and the time to peak motor block were prolonged significantly （ P 〈 0.05 ） , the maximum modified Bromage scale was de-creased statistically （ P 〈 0.01 ）, the recovery time of motor block was shortened （ P 〈 0.05 ） in group R Apgar score of the neonates was similar in two groups. As nausea and vomiting and so on , were not recorded Conclusion Ropivacaine and bupivacaine are effective and safe for CSEA for both parturient and neonate The recovery from motor block is faster with ropivacaine than that with bupivacaine.

关 键 词：罗哌卡因 布比卡因 腰-硬联合阻滞 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]